AB0354 ORBITAL MYOSITIS ASSOCIATED WITH RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW OF CLINICAL FEATURES AND PARACLINICAL DATA
Authors: J. Mahdavi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Orbital myositis (OM) is an inflammatory condition that mainly involves extraocular muscles. The exact etiology of this disease is not known [1]. However, rheumatoid arthritis (RA) has been reported as a possible cause of OM in some cases. <h3>Objectives</h3> The aim of this study was to assess the clinical features and paraclinical data of patients with OM associated with RA. <h3>Methods</h3> This study is a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in PubMed, Web of Science, Scopus, and ScienceDirect for English articles published between 1990 and 2022. Google Scholar was also utilized to find more studies. The keywords used were: "orbital myositis", "ocular myositis", and "rheumatoid arthritis". There was no limitation in age, gender, nationality, and severity of disease. <h3>Results</h3> A total of 6 studies, describing 5 females and 1 male with age ranging from 38 to 61 years, were included [2-7]. The time between the diagnosis of RA and OM was different, with a maximum of 34 years. The most common sign/symptom found in the patients was diplopia (5 cases) followed by proptosis (3 cases), headache (2 cases), drooping eyelid, periorbital swelling, pain on eye movement, conjunctival chemosis, and eye movement limitation (each 1 case). In physical examination, decreased vision and weakness/paralysis of the orbital muscles including medial, lateral, and superior rectus were found. Laboratory data revealed increased thyroxine and mildly raised inflammatory markers including ESR and CRP in 1 case. MRI/CT showed thickening of the involved orbital muscles in all cases and tendon enlargement in 2 cases. Although most of the patients being treated with corticosteroids had good outcomes, paresis of the orbital muscles and mild restriction of horizontal movements due to fibrosis remained as sequels in 2 cases. <h3>Conclusion</h3> Although more research is needed on the relationship between RA and OM, RA should be considered as a rare possible cause of OM, which can lead to nonspecific findings such as headache and elevated inflammatory markers to ocular manifestations like diplopia, proptosis, and drooping eyelid. In addition, in patients with RA and ophthalmological diseases, it is recommended that OM be evaluated as a differential diagnosis to avoid irreversible complications with timely treatment. <h3>References</h3> [1] Montagnese F, Wenninger S, Schoser B. "Orbiting around" the orbital myositis: clinical features, differential diagnosis and therapy. J Neurol. 2016;263(4):631-40. [2] Hoffman J, Fayers T. Painful ophthalmoplaegia secondary to orbital myositis. BMJ Case Rep. 2015;2015. [3] Couderc M, Mathieu S, Tournadre A, Dubost JJ, Soubrier M. Acute ocular myositis occurring under etanercept for rheumatoid arthritis. Joint Bone Spine. 2014;81(5):445-6. [4] Caramaschi P, Biasi D, Carletto A, Bambara LM. Orbital myositis in a rheumatoid arthritis patient during etanercept treatment. Clin Exp Rheumatol. 2003;21(1):136-7. [5] Nabili S, McCarey DW, Browne B, Capell HA. A case of orbital myositis associated with rheumatoid arthritis. Ann Rheum Dis. 2002;61(10):938-9. [6] Panfilio CB, Hernández-Cossio O, Hernández-Fustes OJ. Orbital myositis and rheumatoid arthritis: case report. Arq Neuropsiquiatr. 2000;58(1):174-7. [7] Wheatcroft S, Elston J. Unilateral ptosis due to isolated involvement of the levator muscle in acute orbital myositis. Br J Ophthalmol. 1999;83(5):631-2. <h3>Acknowledgements</h3> I have no acknowledgements to declare. <h3>Disclosure of Interests</h3> None Declared.